• Accurately code complex surgical procedures across multiple specialties • Ensure compliance with CMS, payer policies, and coding guidelines • Apply appropriate modifiers and resolve bundling issues • Review operative notes and clinical documentation for coding accuracy • Support denial reduction through accurate and compliant coding practices • Maintain productivity and quality benchmarks as per organizational standards

• Under direct supervision, ensures professional charges are coded appropriately from the medical record and entered accurately into the billing system. • Codes medical records for multi-specialty physician practices, with a strong focus on Orthopedic professional fee services, including hospital-based Evaluation & Management (E/M) services. • Utilizes ICD-10-CM and CPT coding conventions to assign accurate diagnosis and procedure codes in accordance with established guidelines, payer rules, and compliance standards. • Reviews and analyzes physician documentation, operative reports, and hospital encounter records to accurately assign CPT and ICD-10-CM codes for professional services. • Codes Orthopedic provider services, including office visits, hospital E/Ms, and surgical procedures, ensuring compliance with payer and regulatory guidelines. • Supports multi-specialty professional fee coding, with flexibility to assist across service lines as needed. • Acts as a liaison between coding, billing, and clinical teams to resolve coding questions and documentation issues in a timely manner. • Ensures quality, accuracy, and timeliness of coded data to support reimbursement, reporting, and compliance requirements. • Reviews coding edits, denials, and discrepancies and makes corrections as appropriate. • Meets established productivity, accuracy, and turnaround time standards. • Maintains confidentiality and complies with HIPAA and organizational policies. • Participates in departmental meetings, training sessions, and ongoing education as required.

• Coding. Code a variety of records within established productivity guidelines with at least 95% accuracy on a consistent basis; group and assign DRGs and appropriate E/M levels with at least 95% accuracy on a consistent basis • Abstraction. Abstract ER provider assignment into an abstracting system with at least 99% accuracy on a consistent basis; abstract other required information accurately including discharge dispositions, SPARCS data, physician names and procedure dates • Quality Assurance. Accurately assign the facility charge for emergency room and observation records; identify errors and process accounts for corrections; correct errors identified through various auditing processes; manage problematic workflow edits and other technical issues to ensure timely resolution

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Coding Compliance Specialist is responsible for overseeing and evaluating assigned Risk Adjustment Data Validation (RADV) medical record review (MRR) work performed under the contract. This role ensures compliance with CMS RADV guidelines, coding standards, and risk adjustment policies while maintaining the highest quality and accuracy in medical record documentation. This is a part-time, remote position with flexible scheduling, ideal for experienced professionals seeking autonomy and work-life balance. Key Responsibilities - Ensure adherence to CMS RADV payment and risk adjustment policies. - Provide expert guidance on coding and documentation standards, including ICD-CM, HCC, and Risk Adjustment. - Review escalated Medicare RADV medical record cases and resolve complex issues. - Maintain quality assurance and compliance across all RADV review activities. - Collaborate with stakeholders to improve processes and ensure contractual obligations are met. - Conduct medical record, coding, and policy research. - Develop and deliver training programs related to RADV and coding compliance. - Perform medical record reviews involving PHI/PII, identify conflicting documentation, and provide coding clarifications. Qualifications - Prior experience working directly on the CMS RADV contract is required. - Minimum 5 years of supervisory experience in medical record review, preferably RADV. - Proven expertise in reviewing escalated Medicare RADV medical record cases. - In-depth knowledge of RADV Medical Record Review (MRR) processes, ICD-CM coding standards, CMS RADV payment and risk adjustment policies, and documentation guidelines. Education & Certification - Medical Coding Certification from an accredited entity (e.g., AAPC, AHIMA). - RHIT, RHIA, CCS, CPC, CRC. - Advanced knowledge of coding systems and compliance regulations. Skills & Competencies - Strong analytical and problem-solving skills. - Excellent communication and leadership abilities. - Detail-oriented with a commitment to accuracy and compliance. - Ability to manage multiple priorities and meet deadlines.